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The following is a summary of “Corticosteroids in Cardiogenic Shock: A Retrospective Analysis of the Medical Information Mart for Intensive Care-IV Database,” published in the February 2025 issue of Critical Care by Haddad et al. 

Corticosteroids have been linked to faster shock reversal and reduced short-term mortality in septic shock, but the role in managing cardiogenic shock (CS) remains unclear.  

Researchers conducted a retrospective study to determine the impact of corticosteroid administration on 90-day mortality in patients with CS admitted to a critical care unit.  

They used the critical care database of Medical Information Mart for Intensive Care-IV to include adult patients diagnosed with CS, excluding those with repeated admissions, adrenal insufficiency, baseline corticosteroid use, or requiring extracorporeal life support. Exposure to systemic corticosteroids was defined as administration from 6 hours before to 24 hours after critical care admission. Multivariate Cox proportional hazards analysis was performed to assess 90-day mortality (primary outcome), while additional outcomes, including hospital length of stay, ventilator-free days (VFDs), vasopressor-free days, ventilator-associated pneumonia, central-line-associated bloodstream infections, and hyperglycemia, were also evaluated.  

The results showed 2000 eligible patients with 143 (7.2%) receiving systemic corticosteroids were included. Patients treated with corticosteroid were younger (67.7 vs 71.2 years; P = 0.006), had higher baseline Sequential Organ Failure Assessment scores (9.4 vs 7.8; P < 0.001), and more often required vasopressors (78% vs 63%; P < 0.001) and invasive mechanical ventilation (73% vs 45%; P < 0.001). Multivariate analysis revealed that corticosteroid use was linked to higher 90-day mortality (hazard ratio, 1.60; 95% CI, 1.25–2.05) and fewer VFDs (2.8 days fewer; 95% CI, 0.35–5.26), with no impact on other secondary outcomes.  

Investigators concluded that corticosteroid use in patients with critical illness along with COVID-19 syndrome might have been associated with increased mortality and reduced VFDs but that these potentially harmful findings might reflect unmeasured confounding and warranted further observational studies and randomized controlled trials. 

Source: journals.lww.com/ccejournal/fulltext/2025/02000/corticosteroids_in_cardiogenic_shock__a.3.aspx